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Objective: To assess clinical characteristics and outcomes of women who underwent concurrent valve replacement with caesarean section for severe rheumatic mitral valve disease with refractory heart failure. Methods: All women admitted to a single centre from 2011 to 2020 with severe rheumatic mitral valve disease, having recurrent episodes of pulmonary edema on optimal medical therapy and contraindication to percutaneous balloon mitral valvotomy, who underwent concurrent valve replacement (for native valve disease) along with caesarean section, were included. Results: Among 1300 pregnancies with rheumatic heart disease, six underwent the concurrent procedure. All had replacement of mitral valve except one who had both aortic and mitral valve replacements, between 33 and 39 weeks of gestation. There were no maternal deaths, and there was one neonatal loss from late-onset sepsis. Conclusion: Pregnant women with severe rheumatic mitral valve disease with refractory heart failure, unsuitable for minimal access interventions, can be considered for a concurrent valve replacement with caesarean section. [ABSTRACT FROM AUTHOR]

Adverse Event: Warfarin‐related nephropathy. Drug Implicated: Warfarin. The Patient: A 31‐year‐old female, managed with warfarin for rheumatic heart disease with atrial fibrillation. Evidence that Links the Drug to the Event: There were no alternative causes of nephropathy that could have caused the adverse event in this patient. Management: Shifting the drug from warfarin to acenocoumarol. Mechanism: Difference in renal elimination between warfarin and acenocoumarol. Implication for Therapy: Clinicians should be aware of this rare adverse effect of warfarin, and acenocoumarol can be considered as an alternative therapy for this condition. Hypotheses to be Tested: Further prospectively designed studies are needed to consider acenocoumarol as an alternative therapy in warfarin‐related nephropathy. [ABSTRACT FROM AUTHOR]